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Autonomic Nervous System (Pharma 2002) - Coggle Diagram
Autonomic Nervous System (Pharma 2002)
regulates functions that do not require conscious effort and that are largely involuntary
Sympathetic ANS
AdeNERgic system
sounds like opposite of RUN
types of receptors
alpha
Alpha1 : when you see a tiger, you become PALE
vasoconstriction
contricts internal urethral sphincter
ejaculation
beta
Beta 1 : benim bir kalbim var
stimulation increases heart rate
increased force of contraction
Beta 2 : benim iki akcigerim var
relaxes bronchi
increased cAMP production (going camping, relaxing)
decreases mucus production
stimulated by norepinephrine
sympathomimetics
catecholamines
natural
epinephrine
norepinephrine
dopamine
synthetic
isoprenaline
dobutamine
fenoldopam
non-catecholamines
salbutamol
amphetamine
phenylephrine
ephedrine
xylometazoline
selectivity
phenylephrine (selective alpha1 agonist)
constricts skin, cutaneous, visceral (sphlancnic), pulmonary, renal blood vessels
constrict veins
often evokes a compensatory reflex bradycardia
midodrine (selective alpha1 agonist)
used in hypotension
produces mydriasis (ophthalmologic exam)
used for glaucoma
decongestant when given locally
alpha 2 agonists
clonidine (presynaptic alpha2 receptors)
antihypertensive drug
pain killer
methyldopa
brimonidine
apraclonidine (postsynaptic alpha2 receptors)
both alpha1 and alpha2
naphazoline
oxymetazoline
dobutamine (selective beta1 agonist)
increase heart rate, contraction, conduction velocity
increase renin secretion
used in heart failure
beta 2
salbutamol
used in asthma
terbutaline
relaxation of tracheal and bronchial muscle
can lead to tremors in skeletal muscles
may be used in premature labor
salmeterol
both beta1 and beta2
isoprenaline
used for bradycardia
both alpha and beta agonist
direct acting
adrenaline
used to prolong action of local anesthetics
antagonist of histamine
noradrenaline
dominating reflex bradycardia
both direct and indirect (ephedrine)
treating hypotension linked to spinal anesthesia
CNS application
long-acting
indirect acting
by increasing release
amphetamine
methamphetamine
by inhibiting reuptake
imipramine
cocaine
D1 agonist (dopamine)
fenoldopam
very useful in treatment of renal failure associated with shock (low to moderate dose)
dopamine
used in cardiogenic shock
toxicity (MATHS)
mydriasis
agitation, arrythmia, angina
tachycardia
hypertension, hyperthermia
seizure, sweating
sympatholytics
alpha blockers
selective
alpha1 (end with zosine)
prazosin
may provide relief for Raynaud's phenomenon
first-dose effect
highly selective alpha1 antagonist
terazosin
doxazosin
alfuzosin
side effects of alpha1 blockers
first dose effect
may cause orthostatic hypotension, the patient must start taking the medicine in small doses and at night
common with prazosin
nasal congestion
decreased ejaculation
headache - due to cranial vasodilation
reflex tachycardia
more common with nonselective agents
miosis
alpha2
yohimbine
mirtazapine (antidepressant)
non-selective
reversible
phentolamine
tolazoline
irreversible
phenoxybenzamine
treatment of hypertension due to pheochromocytoma
beta blockers
first generation (non-selective)
propranolol
crosses blood-brain barrier
social anxiety migraine treatment
has a membrane stabilising effect (blocks sodium influx)
used in pathological tremor
antiarrythmic
pindolol
nadolol (10-20h, longest half-life)
sotalol
timolol
used in glaucoma (decreases intraocular tension)
cannot be used on pregnant, diabetic or asthmatic patients
second generation (beta1 selective)
atenolol (5-8h)
acebutolol
antiarrythmic
bisoprolol (11-17h)
esmolol (9 min)
shortest half-life
present in IV preparations, used in emergency settings
antiarrythmic
metoprolol
must be used to treat hypertension in asthmatic patients
decrease cardiac output and work
third generation
non-selective (beta and alpha1)
carvedilol
antioxidant potential
blocks calcium channels (decreased force of contraction, negative inotropic effect)
used in cogestive heart failure
labetalol
can be used on pregnant patients
decreases mortality rate
used in hypertensive emergencies
selective (beta1)
nebivolol
third generation because it produces nitric oxide
betaxolol
may lead to hypoglycemia
withdrawal may lead to rebound hypertension, must be removed slowly/replaced
antidote for beta blocker overdose = glucagon
Parasympathetic
CHOLinergic system
sounds like COOL
types of receptors
nicotinic
ligand-gated ion channels
muscarinic
G-protein coupled receptors
M1 : CNS
most important organ
learning & memory functions
M2 : heart
stimulation decreases heart rate and contractility
2nd most important system
M3 : smooth muscle, exocrine glands, bladder
constricts bronchi
stimulates mucus production, increased airway resistance
contracts wall of bladder
stimulated by acetylcholine
cholinergic crisis (DUMBELLS)
diarrhea
urination
miosis (pinpoint pupils)
bradycardia
emesis (nausea and vomiting)
lacrimation
lethargy
salivation
cholinomimetics
direct acting
muscarinic
pilocarpine
contraction of ciliary muscles
used in treatment of xerostomia, glaucoma
+cystic fibrosis sweat test
cevimeline
bethaneCHOL
urinary retention
nicotinic
both
acetylcholine
methaCHOLine (M > N)
asthma challenge test
diagnosis of bronchial airway reactivity
indirect acting (no receptors)
anticholinesterase
physostigmine
can cross the CNS
antidote for atropine overdose
malathion
irreversible (warfare weapons, pesticides)
parathion
echothiophate
may cause glaucoma
miosis
accomodation (near vision)
effects are seen in the
lungs
bronchoconstriction
increased tracheobronchial secretions
gastrointestinal tract
increased amplitude of contractions
relax sphincter
increased secretions
urinary tract
relaxation of sphincter
CNS
memory
contraindications
bronchial asthma
recent myocardial infarction
coronary insufficiency
GI or urinary tract obstruction
anticholinergics
antimuscarinic
M1 selective
pirenzepine
Nonselective
atropine
high doses cause
hot as a hare (increased temperature, decreased sweating)
mad as a hatter (confusion, delirium)
red as a beet (flushed face, tachycardia)
dry as a bone (decreased secretions, thirsty)
blind as a bat (mydriasis & cyclopegia)
more prominent in children
treatment of toxicity = physostigmine (can cross BBB, solve CNS problems)
effects
CNS
sedation
anti-motion sickness
anti-parkinson
eye (block of M3 receptors)
mydriasis (dilation of pupil)
cycloplegia (paralysis of circular muscles of the eye)
blurred vision, loss of accomodation
genitourinary tract
relaxation of bladder wall, urinary retention
antinicotinic
ganglion blockers
hexamethonium
neuromuscular blockers
tubocurarine
cholinesterase regenerators
oximes (pralidoxime)
used to treat organophosphate poisoning
scopolamine (used for motion sickness)
tiotropium (treatment of COPD)
tropicamide, cyclopentolate (opthalmology, topical)
benztropine (Parkinsons) - mercedez bens owned by rich people, Parkinsons usually occurs in rich people
oxybutynin, solifenacin (overactive bladder)